CurrentMVP Health CarePolicy N/A

Vermont Value Drug List (MVP VT Plus)

Lists prescription medications offered at $1 or $3 copay for certain MVP VT Plus (Non-Standard) plans in Vermont and instructs members to consult their prescriber and plan documents to confirm availability.

Policy Summary

PayerMVP Health Care

PolicyVermont Value Drug List (MVP VT Plus)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionVerify the member's specific benefit documents and contact the prescriber to confirm if a listed value drug is appropriate and covered.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1-3copay options

30-daysupply period

VTstate

MVP VT Plusplans

Coverage Criteria

Not all drugs listed on the Vermont Value Drug list are included on every MVP plan. Coverage is determined by the member's specific plan documents, which define benefits, limitations, and exclusions. This document is informational and does not guarantee coverage; providers and members should confirm benefits for a given member before prescribing or filling a medication.

Provider Actions & Verification

Denial Risk

Coverage Not Guaranteed

Coverage depends on the member's specific plan documents. Review the member's benefit documents to confirm whether the MVP VT Plus plan includes the listed value drugs; this document is not a guarantee of coverage.

Contact MVP Customer Care: 1-800-348-8515 (TTY 1-800-662-1220)

Prior Authorization

Policy Summary

PayerMVP Health Care

PolicyVermont Value Drug List (MVP VT Plus)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionVerify the member's specific benefit documents and contact the prescriber to confirm if a listed value drug is appropriate and covered.

SourceLink

On This Page

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Background

This document presents the Vermont Value Drug list, a formulary-style list of lower-cost preferred medications offered for certain MVP VT Plus (Non-Standard) plans in Vermont. Medications on the list are offered at reduced prescription co-pays (e.g., $1 or $3 for a 30-day supply) for eligible members, but availability is limited to the plans that include the value-drug benefit and may change based on decisions by the MVP Pharmacy and Therapeutics Committee. Providers should use this list as a reference and verify a member's plan documents and coverage before selecting therapy.

Definitions

Vermont Value Drug list — definition and summary

DefinitionVermont Value Drug list: a set of medications offered at a $1 or $3 prescription drug co-pay for a 30-day supply for eligible MVP VT Plus (Non‑Standard) plans.

Plan applicabilityOffered with most MVP VT Plus (Non‑Standard) plans; availability depends on the specific MVP VT Plus plan in which the member is enrolled.

Copay optionsMedications on the list are available at either a $1 or $3 copay for a 30‑day supply, depending on the member’s plan.

Member actionMembers should review their specific benefit documents to confirm whether their plan includes these value drugs and contact their prescriber to discuss suitability.

GovernanceList is maintained by MVP Pharmacy and Therapeutics processes and is subject to change; prescribers determine appropriate treatment for each patient.